2446.04 Attachment 2- EPA Form 9600-049

2446.04__Attach 2_EPAForm 9600-049.pdf

Formaldehyde Emissions Standards for Composite Wood Products Act (Renewal)

2446.04 Attachment 2- EPA Form 9600-049

OMB: 2070-0185

Document [pdf]
Download: pdf | pdf
OMB Control Number 2070-0185 expires 9/30/2024

Third-Party	Certifier	Annual	Report
Unique	Form	ID:			TPC-AR-40639
Reporting	Year

2023

Shared	with	CARB?

N

List	of	Panel	Producers
Panel	Producer	-	1
Panel	Producer	Name

Test	Producer

Panel	Producer	Address

1234	Test	Street,	Suite	200,	City,	55555,	ANDORRA

CBI

Panel	Producer	-	1:	Product	Information
Product	Name

test	1

Product	Type

test	1

Resin	Type
Panel	Producer	-	1:	Product	Information:	Lot	-	1
Test	Date

12/30/2022

Lot	Number-	1

500000

Test	Method
method	1		
Volume	(in	Cubic	Meters)

150000

Result	of	Re-Certification	Testing
pass		
Description	of	Disposition	of	Affected	Product
test		
Failed	Quarterly	Test

TPC-FQT-31193

QCL	Exceedance

TPC-QCLE-30997

Panel	Producer	-	1:	Quarterly	Test
Inspection	Date

N/A

Quarterly	Test	Date

N/A

Quarter
Test	Method

N/A

Contract	Laboratory

N

Form 9600-049

CBI

X

Paperwork Reduction Act: This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB
Control No. 2070-0185). Responses to this collection of information are mandatory for certain persons, as specified at 40 CFR 770. An agency may not
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Include the OMB control number in any correspondence. Do not send the completed form to this address.

Panel	Producer	-	1:	Quarterly	Test
Inspection	Date

01/01/2022

Quarterly	Test	Date

01/01/2022

Quarter

Q1

Test	Method

BS	EN	ISO	12460-3:2015

Contract	Laboratory

N

Panel	Producer	-	1:	Quarterly	Test:	Product	Test	-	1
Product	Name

test	2

Product	Type

test	2

Volume	(in	Cubic	Meters)

50300

Result	of	Re-Testing

test	

Disposition

test	

Panel	Producer	-	1:	Quarterly	Test
Inspection	Date

04/01/2022

Quarterly	Test	Date

04/01/2022

Quarter

Q2

Test	Method

ASTM	D5582-14

Contract	Laboratory

N

Panel	Producer	-	1:	Quarterly	Test:	Product	Test	-	1
Product	Name

test	3

Product	Type

test	3

Volume	(in	Cubic	Meters)

40000

Result	of	Re-Testing

test	

Disposition

test	

Panel	Producer	-	1:	Quarterly	Test
Inspection	Date

07/01/2022

Quarterly	Test	Date

07/01/2022

Quarter

Q3

Test	Method

DMC	(Dynamic	Micro	Chamber),	2007	User's	Manual

Contract	Laboratory

N

Panel	Producer	-	1:	Quarterly	Test:	Product	Test	-	1
Form 9600-049

Product	Name

prod	with	1	test

Product	Type

type	4

Volume	(in	Cubic	Meters)

8000000

Result	of	Re-Testing

test	

Disposition

N/A

Panel	Producer	-	1:	Quarterly	Test
Inspection	Date

12/01/2022

Quarterly	Test	Date

12/01/2022

Quarter

Q4

Test	Method

JIS	A1460:2015

Contract	Laboratory

N

Panel	Producer	-	1:	Quarterly	Test:	Product	Test	-	1
Product	Name

prod	with	1	test

Product	Type

type	4

Volume	(in	Cubic	Meters)

600

Result	of	Re-Testing

test	

Disposition

N/A

List	of	Laboratories
Laboratory	Report	-	1
Laboratory	Name

Test	Laboratory	N/A

Laboratory	Address

1234	Main	Street,	City,	Alabama	N/A,	UNITED	STATES

Primary	Contact

William	Brigman

Primary	Contact	Email

william.brigman@cgifederal.com

Primary	Contact	Phone	No.

8281111234

Secondary	Contact

N/A

Secondary	Contact	Email

N/A

Secondary	Contact	Phone	No.

N/A

Laboratory	Accreditation

test

Date	of	Small	Chamber	Method
Equivalence

12/31/2022

Laboratory	Report	-	1:	List	of	Equivalence	Data	Point	Sets

CBI

Equivalence	Data	Point	Set	-	1
Large	Chamber	Result	(ppm)

15

Small	Chamber	Result	(ppm)

756

Small	Chamber	Equivalent	to
Large	Chamber?

N
CBI

Equivalence	Data	Point	Set	-	2
Large	Chamber	Result	(ppm)

1000

Small	Chamber	Result	(ppm)

1000

Small	Chamber	Equivalent	to
Large	Chamber?

N
CBI

Equivalence	Data	Point	Set	-	3
Large	Chamber	Result	(ppm)

40000

Small	Chamber	Result	(ppm)

30

Small	Chamber	Equivalent	to
Large	Chamber?

N
CBI

Equivalence	Data	Point	Set	-	4
Large	Chamber	Result	(ppm)

300

Small	Chamber	Result	(ppm)

44

Small	Chamber	Equivalent	to
Large	Chamber?

N
CBI

Equivalence	Data	Point	Set	-	5
Large	Chamber	Result	(ppm)

400

Small	Chamber	Result	(ppm)

400

Small	Chamber	Equivalent	to
Large	Chamber?

N

Inter-Laboratory	Comparison
Participated	in	an	InterLaboratory	Comparison?

N

List	of	Non-Conformities
Submitter
Prefix

First	Name

Last	Name

William

Brigman

Organization	Name

CDX	Test	Org

Suffix

Phone	Number

8289191634

Email	Address

william.brigman@cgifederal.com

Mailing	Address	1

123	Main	St

Mailing	Address	2
City

State

Postal	Code

Country

Virginia	Beach

Virginia

23462

UNITED	STATES

General	Claim:	Submitter	Information
Applicable	Only	to	General	CBI	Claims
A	person	may	assert	a	claim	of	confidentiality	for	the	specific	chemical	identity	of	a
chemical	substance	as	described	in	§	711.15(b)(3)	of	this	part	only	if	the	identity	of	that
chemical	substance	is	treated	as	confidential	in	the	Master	Inventory	File	as	of	the	time	the
report	is	submitted	for	that	chemical	substance.	Generic	chemical	identities	and	accession
numbers	may	not	be	claimed	as	confidential.	To	assert	a	claim	of	confidentiality	for	the
identity	of	a	reportable	chemical	substance,	you	must	submit	with	the	report	detailed	written
answers	to	the	questions	from	subsection	(b)	and	to	the	following	questions.
Question
G1)	Please	specifically	explain	what	harm	to	the
competitive	position	of	your	business	would	be	likely	to
result	from	the	release	of	the	information	claimed	as
confidential.	How	would	that	harm	be	substantial?	Why	is
the	substantial	harm	to	your	competitive	position	likely
(i.e.,	probable)	to	be	caused	by	release	of	the	information
rather	than	just	possible?	If	you	claimed	multiple	types	of
information	to	be	confidential	(e.g.	site	information,
exposure	information,	environmental	release	information,
etc.),	explain	how	disclosure	of	each	type	of	information
would	be	likely	to	cause	substantial	harm	to	the
competitive	position	of	your	business.

Yes

No

X

CBI

X

Comment:	Test

Question
G2)	Has	your	business	taken	precautions	to	protect	the
confidentiality	of	the	disclosed	information?	If	yes,	please
explain	and	identify	the	specific	measures,	including	but

Yes

No

CBI

not	limited	to	internal	controls,	that	your	business	has
taken	to	protect	the	information	claimed	as	confidential.	If
the	same	or	similar	information	was	previously	reported	to
EPA	as	non-confidential	(such	as	in	an	earlier	version	of
this	submission),	please	explain	the	circumstances	of	that
prior	submission	and	reasons	for	believing	the	information
is	nonetheless	still	confidential.

X

X

Comment:	Test

Question
G3A)	Is	any	of	the	information	claimed	as	confidential
required	to	be	publicly	disclosed	under	any	other	Federal
law?	If	yes,	please	explain.

Yes

No

CBI

No

CBI

No

CBI

No

CBI

X

Comment:	Test

Question
G3B)	Does	any	of	the	information	claimed	as	confidential
otherwise	appear	in	any	public	documents,	including	(but
not	limited	to)	safety	data	sheets;	advertising	or
promotional	material;	professional	or	trade	publications;
state,	local,	or	Federal	agency	files;	or	any	other	media	or
publications	available	to	the	general	public?	If	yes,	please
explain	why	the	information	should	be	treated	as
confidential.

Yes

X

Comment:	Test

Question
G3C)	Has	a	patent	been	published	for	the	chemical	identity
you	claim	confidential?	What	chemical	identity	information
is	not	revealed	by	the	patent?	How	is	release	of	that
specific	information	likely	to	cause	substantial	competitive
harm?	And	failure	to	explain	this	harm	may	lead	to	denial
of	your	confidentiality	claim.

Yes

X

Comment:	Test

Question
G4)	Is	the	claim	of	confidentiality	intended	to	last	less	than
10	years	(see	TSCA	section	14(e)(1)(B))?	If	yes,	please

Yes

X

indicate	the	number	of	years	(between	1-10	years)	or	the
specific	date	after	which	the	claim	is	withdrawn.
Comment:	Test

Question
G5)	Has	EPA,	another	federal	agency,	or	court	made	any
confidentiality	determination	regarding	information
associated	with	this	chemical	substance?	If	yes,	please
provide	the	circumstances	associated	with	the	prior
determination,	whether	the	information	was	found	to	be
entitled	to	confidential	treatment,	the	entity	that	made	the
decision,	and	the	date	of	the	determination.
Comment:	Test

Yes

X

No

CBI


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File Created2023-01-18

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